I am a plastic surgeon in Little Rock, AR. I used to "suture for a living", I continue "to live to sew". These days most of my sewing is piecing quilts. I love the patterns and interplay of the fabric color. I would like to explore writing about medical/surgical topics as well as sewing/quilting topics. I will do my best to make sure both are represented accurately as I share with both colleagues and the general public.

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Wednesday, September 23, 2009

Updated 3/2017-- all links (except to my own posts) removed
as many no longer active. and it was easier than checking each one.

This topic has become more real for my family. My first cousin’s son-in-law committed suicide this past weekend. He had had difficulty adjusting since his return from Iraq, but the family was still caught off-guard. If you can make it any worse, he chose his wife’s birthday to take his life. Fortunately, neither she nor their toddler son was home at the time.

The issue of soldier suicide concerns many. Maj. Gen. William D. Wofford, Arkansas' National Guard Adjutant General, recently made a public plea for help asking family members, friends and employers of the state's 10,000 Guardsmen to watch for personality changes or signs of stress overwhelming his soldiers and airmen. There has been four suicides in Arkansas Guardsmen since January.

As Dr Chad Morrow points out the suicide risk for active duty males is now higher than for the general population.

This is particularly noteworthy considering that the military entrance process screens out serious mental illness prior to entry onto active duty, and that the rate of suicide in military males has historically been significantly lower than comparable civilian populations.

Morrow goes on to touch on “the three-way interaction between burdensomeness, belongingness, and acquired capability.” He suggests that “belongingness is less robustly related to suicidal desire than burdensomeness.”

I don’t know if my young cousin-in-law’s suicide could have been prevented. He came back from Iraq physically intact. I’m not sure how much help he sought or took advantage of. I do know he has left loved ones who now have to face their grief, the loss of his presence, and many questions.

Here are some of my random thoughts on suicide prevention in our troops:

They need to feel connected. We know that text messages have been helpful in getting patients to do better with their chronic diseases or take their meds. Is there anyway to use text messages to help them feel more connected?

Could the military and/or guard set up a “facebook” system for the troops where they could interact with each other? Virtual “group sessions” that would overcome distance (living too far from a VA Clinic), like telemedicine.

Solders, like physicians, have a higher completion rate on suicides than the general public. You can’t take away the training needed to do our jobs. The focus has to be on connecting, feeling useful/needed/capable.

Each individual has to reach out and grab the lifeline that is thrown his way.

Sources

Ark. National Guard asks for help as suicides rise; AR State Wire By Jon Gambrell, Published: Sep 18, 2009

Sorry to hear about this, Ramona. I hope you and your family--particularly the wife and child he left behind--find peace. You are already honoring his memory by raising awareness on this important topic.

I am saddened to read of your family's loss. It is a devastating loss.

Our military people who have volunteered to serve are a precious resource and we need to help those who have returned physically sound.

As a Vietnam vet who has dealt with the many demons that can assail a combat survivor, I would like to see the military be proactive in making available group sessions to those who have returned and are finding it difficult.

There are three issues that loom large for combat survivors. The first is the stress of having seen and done things, which stress our humanity to its limits. The second is the sense of guilt as a survivor. Many men (and women today) return feeling guilty that they survived when their best friend or friends didn't. Add to that the difficulty of decompressing from having lived in a state of almost constant fight or flight readiness. One or all of those things can overwhelm one's ability to transition back into civilian society.

To be able to be guided by a therapist in talking with others who are dealing with the same issues can help to defuse and put into perspective the many warring emotions that lead to a sense of hopelessness.

This was a big issue after Vietnam and will be a big issue going forward during this time of war. The lessons of dealing with PTSD have been somewhat forgotten. (Institutional memory is never very lasting.) I hope the National Guard units will pick up on this and be proactive in offering this to their members.

I would like to expand on one point that Jimmy J. mentioned: decompression.

It is probably much harder for guardsmen and reserve units to decompress as they are residentially scattered. This was a problem I first became aware of when my daughter was setting up Family Resource Groups for reserve units.

Though she had run the FRG for her husband's unit during his first deployment to Iraq in 2003/2004, she found it very difficult to get the spouses together for a deployed reserved unit -- they didn't live close together and they didn't share a common lifestyle.

When her husband's unit returned home, there was an entire Fort out to greet them and they had several weeks together getting things "stowed away" as they returned to stateside duty.

My daughter also threw a huge welcome home party for her husband, inviting every one in the unit and their families.

The men talked non-stop about their experiences, both good and bad. Many of them expressed a desire to go back, as they felt they did not finish their job. I don't know how many kegs of beer or lbs of BBQ this group devoured, but the party lasted for hours.

How many reserve and guard units have that sort of opportunity to decompress among themselves in a loving and accepting environment?

I also have a step-son who served in Desert Storm in the USAF and is now a member of the Georgia Air National Guard. He's been to Afghanistan three times, but never for more than six months. Since his civilian job was aircraft maintenance for the Guard, his experience was more similar to active duty also.

I think one of the problems is that through technology we can get our soldiers out of combat too quickly. It's got to be a huge adjustment to make in 24 to 36 hours flight time.

Is there a way cities and communities can come together to provide some kind of "decompression" event for Guard and reserve units? I really don't think a parade or a welcome home banner is quite enough.

(footnote: My son's-in-law unit lost 3 Soldiers to vehicle/motorcycle accidents within 2 months of returning and I have always wondered if excess risk-taking was not a passive form of suicide.)

Very poignant Ramona. I am so sorry that you lost a loved one to suicide. My best friend took her life the beginning of November. It's a HORRIBLE way to lose someone and leaves such a devastating mess for those that are left behind. Every day has been about putting one step in front of the other.

I also have a brother that did a 15 month deployment in Iraq - Army Stryker Brigade. He doesn't like to talk about it, and I don't blame him. On top of it, he is Bipolar I. Adjusting was hard for him and he has been home for over a year. His marriage ended after coming home. I check in with him to make sure he is taking his mood stabilizer,anti depressant etc. and following up and keeping his appointments with the psychiatrist at the VA. He lives in another state, so I don't see him on a regular basis.

Jimmy J. hit the nail on the head with his comments. I think the exhaustion of living in a hypervigilant state while deployed to war is indeed very draining emotionally.

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